Download PDF
Gastroenterologie up2date 2015; 11(03): 215-231
DOI: 10.1055/s-0034-1392575
Endoskopie/Gastrointestinale Radiologie/Sonografie
© Georg Thieme Verlag KG Stuttgart · New York

Kurative Tumortherapie in der Endoskopie

Andreas Probst
Further Information

Publication History

Publication Date:
02 September 2015 (online)

Also available at
    Permissions and Reprints All articles of this category
Kernaussagen

  • Die ER gastrointestinaler Frühmalignome wurde in den letzten Jahren durch neue Verfahren (ESD, EFTR) weiterentwickelt. Insbesondere die ESD hat durch eine Verbesserung der R0-Resektionsrate und ein vermindertes Rezidivrisiko die Möglichkeit kurativer Resektionen deutlich verbessert.

  • Vor einer ER sollte das Malignitätsrisiko anhand morphologischer Kriterien möglichst exakt beurteilt werden, um die Notwendigkeit einer En-bloc-Resektion einzuschätzen. Die diagnostischen Möglichkeiten wurden durch die technischen Entwicklungen in den letzten Jahren erheblich verbessert (insbesondere durch digitale Strukturverstärkungsverfahren wie z. B. NBI).

  • Histologische Kriterien entscheiden, ob eine ER als alleinige Therapie onkologisch kurativ sein kann. Im Wesentlichen sind dies Invasionstiefe, Grading und lymphovaskuläre Invasion.

  • Die Resektionskriterien unterscheiden sich organbezogen und sind für Barrett-Frühkarzinom, Magenfrühkarzinom und kolorektales Frühkarzinom in Leitlinien der DGVS festgelegt.

 

  • Literatur

  • 1 Schmidt A, Bauerfeind P, Gubler C et al. Endoscopic full-thickness resection in the colorectum with a novel over-the-scope device: first experience. Endoscopy (Epub ahead of print) DOI: 10.1055/s-0034-1391781.
    PubMedGoogle Scholar
  • 2 Endoscopic Classification Review Group. Update on the Paris Classification of Superficial Neoplastic Lesions in the Digestive Tract. Endoscopy 2005; 37: 570-578
    Article in Thieme ConnectPubMedGoogle Scholar
  • 3 Rubenstein JH, Shaheen NJ. Epidemiology, Diagnosis, and Management of Esophageal Adenocarcinoma. Gastroenterology (Epub ahead of print) DOI: 10.1053/j.gastro.2015.04.053.
    PubMedGoogle Scholar
  • 4 Pech O, May A, Manner H et al. Long-term efficacy and safety of endoscopic resection for patients with mucosal adenocarcinoma of the esophagus. Gastroenterology 2014; 146: 652-660
    CrossrefPubMedGoogle Scholar
  • 5 Manner H, Pech O, Heldmann Y et al. The frequency of lymph node metastasis in early-stage adenocarcinoma of the esophagus with incipient submucosal invasion (pT1b sm1) depending on histological risk patterns. Surg Endosc (Epub ahead of print) DOI: 10.1007/s00464-014-3881-3.
    PubMedGoogle Scholar
  • 6 Koop H, Fuchs KH, Labenz J et al. S2k-Leitlinie: Gastroösophageale Refluxkrankheit unter Federführung der Deutschen Gesellschaft für Verdauungs- und Stoffwechselkrankheiten (DGVS). Z Gastroenterol 2014; 52: 1299-1346
    Article in Thieme ConnectPubMedGoogle Scholar
  • 7 Probst A, Aust D, Märkl B et al. Early esophageal cancer in Europe: endoscopic treatment by endoscopic submucosal dissection. Endoscopy 2015; 47: 113-121
    Google Scholar
  • 8 Li B, Chen H, Xiang J et al. Prevalance of lymph node metastases in superficial esophageal squamous cell carcinoma. J Thorac Cardiovasc Surg 2013; 146: 1198-1203
    CrossrefPubMedGoogle Scholar
  • 9 Guo HM, Zhang XQ, Chen M et al. Endoscopic submuocsal dissection vs endoscopic mucosal resection for superficial esophageal cancer. World J Gastroenterol 2014; 20: 5540-5547
    CrossrefPubMedGoogle Scholar
  • 10 Inoue H, Kaga M, Ikeda H et al. Magnification endoscopy in esophageal squamous cell carcinoma: a review of the intrapapillary capillary loop classification. Ann Gastroenterol 2015; 28: 41-48
    PubMedGoogle Scholar
  • 11 Isomoto H, Shikuwa S, Yamaguchi N et al. Endoscopic submucosal dissection for early gastric cancer: a large-scale feasibility study. Gut 2009; 58: 331-336
    CrossrefPubMedGoogle Scholar
  • 12 Lian J, Chen S, Zhang Y et al. A meta-analysis of endoscopic submuocsal dissection and EMR for early gastric cancer. Gastrointest Endosc 2012; 76: 763-770
    CrossrefPubMedGoogle Scholar
  • 13 Probst A, Pommer B, Golger D et al. Endoscopic submucosal dissection in gastric neoplasia – experience from a European center. Endoscopy 2010; 42: 1037-1044
    Article in Thieme ConnectPubMedGoogle Scholar
  • 14 Oka S, Tanaka S, Kaneko I et al. Advantage of endoscopic submucosal dissection compared with EMR for early gastric cancer. Gastrointest Endosc 2006; 64: 877-883
    CrossrefPubMedGoogle Scholar
  • 15 Takao M, Kakushima N, Takizawa K et al. Discrepancies in histologic diagnoses of early gastric cancer between biopsy and endoscopic mucosal resection specimens. Gastric Cancer 2012; 15: 91-96
    CrossrefPubMedGoogle Scholar
  • 16 Japanese Gastric Cancer Association. Japanese classification of gastric carcinoma - 2nd english edition. Gastric Cancer 1998; 1: 10-24
    CrossrefPubMedGoogle Scholar
  • 17 Gotoda T, Yanagisawa A, Sasako M et al. Incidence of lymph node metastasis from early gastric cancer: estimation with a large number of cases at two large centers. Gastric Cancer 2000; 3: 219-225
    CrossrefPubMedGoogle Scholar
  • 18 Soetikno R, Kaltenbach T, Yeh R et al. Endoscopic mucosal resection for early cancer of the upper gastrointestinal tract. J Clin Oncol 2005; 10: 4490-4498
    PubMedGoogle Scholar
  • 19 Bollschweiler E, Berlth F, Baltin C et al. Treatment of early gastric cancer in the Western World. World J Gastroenterol 2014; 20: 5672-5678
    CrossrefPubMedGoogle Scholar
  • 20 Möhler M, Al-Batran SE, Andus T et al. German S3-guideline „Diagnosis and treatment of esophagogastric cancer”. Z Gastroenterol 2011; 49: 461-531
    Article in Thieme ConnectPubMedGoogle Scholar
  • 21 Gotoda T, Iwasaki M, Kusano C et al. Endoscopic resection of early gastric cancer treated by guideline and expanded National Cancer center criteria. Br J Surg 2010; 97: 868-871
    CrossrefPubMedGoogle Scholar
  • 22 Probst A, Anthuber M, Märkl B et al. Endoscopic submucosal dissection (ESD) in early gastric cancer (EGC) – resection beyond the “guideline criteria” in Europe. UEG Week 2013; Oral Presentation 083
    PubMedGoogle Scholar
  • 23 Leitlinienprogramm Onkologie (Deutsche Krebsgesellschaft, Deutsche Krebshilfe, AWMF): S3-Leitlinie Kolorektales Karzinom, Langversion 1.0, AWMF Registrierungsnummer: 021-007OL. Im Internet: http://leitlinienprogramm-onkologie.de/Leitlinien.7.0.html (Stand: 18.6.2015)
    PubMedGoogle Scholar
  • 24 Uraoka T, Saito Y, Matsuda T et al. Endoscopic indications for endoscopic mucosal resection of laterally spreading tumors in the colorectum. Gut 2006; 55: 1592-1597
    CrossrefPubMedGoogle Scholar
  • 25 Probst A, Golger D, Anthuber M et al. Endoscopic submucosal dissection in large sessile lesions of the rectosigmoid: learning curve in a European Center. Endoscopy 2012; 44: 660-667
    Article in Thieme ConnectPubMedGoogle Scholar
  • 26 Ikematsu H, Matsuda T, Emura F et al. Efficacy of capillary pattern type IIIA/IIIB by magnifying narrow band imaging for estimating depth of invasion of early colorectal neoplasms. BMC Gastroenterology 2010; 10: 33
    CrossrefPubMedGoogle Scholar
  • 27 Saito Y, Fukuzawa M, Matsuda T et al. Clinical outcome of endoscopic submucosal dissection versus endoscopic mucosal resection of large colorectal tumors as determined by curative resection. Surg Endosc 2010; 24: 343-352
    CrossrefPubMedGoogle Scholar
  • 28 Saito Y, Uraoka T, Yamaguchi Y et al. A prospective multicenter study of 1111 colorectal endoscopic submucosal dissections (with video). Gastrointest Endosc 2010; 72: 1217-1225
    CrossrefPubMedGoogle Scholar
  • 29 Delle Fave G, Kwekkeboom DJ, Van Cutsem EV et al. ENETS Consensus Guidelines for the Management of Patients with Gastroduodenal Neoplasms. Neuroendocrinology 2012; 95: 74-78
    CrossrefPubMedGoogle Scholar
  • 30 Caplin M, Sundin A, Nilsson O et al. ENETS Consensus Guidelines for the Management of Patients with Digestive Neuroendocrine Neoplasms: Colorectal Neuroendocrine Neoplasms. Neuroendocrinology 2012; 95: 88-97
    CrossrefPubMedGoogle Scholar